CHILDREN AND YOUNG PEOPLE S TRACKING OUTCOMES Resource Pack. Version Child/Young Person Measures Parent/Carer Measures Practitioner Resources

Transcription

1 CHILDREN AND YOUNG PEOPLE S TRACKING OUTCOMES Resource Pack Version Child/Young Person Measures Parent/Carer Measures Practitioner Resources

2 Issued May 2012 For contact and comments

3 CHILDREN AND YOUNG PEOPLE S TRACKING OUTCOMES Resource Pack Version CONTENTS 7 WELCOME 8 The Children and Young People s Improving Access to Psychological Therapies Tracking Outcomes Resource Pack 9 Membership of Outcomes and Evaluation Task and Finish Group (OEG) 9 With brief information on key relevant expertise 10 Using information from clinical tools to improve clinical practice 10 Overview of Measures 12 CONSENT TO SHARE INFORMATION 13 Gaining Consent to share data: information for practitioners 13 The approach we are taking 13 Who gives consent? 13 Who completes the form? 13 Participation is voluntary 14 Consent to share information: Improving Access to Psychological Therapy for Children & Young People 14 Our request 14 Our promise 14 By signing this consent form you are agreeing that: 14 Your participation is voluntary 15 Parental Consent to share information: Improving Access to Psychological Therapy for Children & Young People 15 Our request 15 Our promise 15 By signing this consent form you are agreeing that: 15 Your participation is voluntary Contents -3

4 16 CHILD/ YOUNG PERSON MEASURES 17 ASSESSMENT 18 Strengths and Difficulties Questionnaire S RCADS 22 SESSION BY SESSION - GOAL OR GLOBAL TRACKING 23 Goal progress chart 24 Outcome Rating Scale (ORS) 25 Child Outcome Rating Scale (CORS) 26 Young Child Outcome Rating Scale (YCORS) 27 SESSION BY SESSION - SYMPTOM TRACKING 28 How are things? 38 SESSION BY SESSION - IMPACT TRACKING 39 How are you doing? 40 SESSION BY SESSION - FEEDBACK TRACKING 41 How was this meeting? 42 Session Rating Scale (SRS V.3.0) 43 Child Session Rating Scale (CSRS) 44 Young Child Session Rating Scale (YCSRS) age 5 and under 45 Group Session Rating Scale (GDRC) 46 Child Group Session Rating Scale (CGSRS) 47 REVIEW 48 Strengths and Difficulties Questionnaire S11-17 Follow-up 50 RCADS 52 CHI Experience of Service Questionnaire Day Services (9-11) 54 CHI Experience of Service Questionnaire Day Services (12-18) Contents -4

5 56 PARENT/ CARER MEASURES 57 ASSESSMENT 58 Strengths and Difficulties Questionnaire P 3/4 60 Strengths and Difficulties Questionnaire P RCADS 64 SESSION BY SESSION - GOAL OR GLOBAL TRACKING 65 Goal progress chart 66 Outcome Rating Scale (ORS) 67 SESSION BY SESSION - SYMPTOM TRACKING 68 How are things? 69 How are things? 75 SESSION BY SESSION - IMPACT TRACKING 76 How is your child doing? 77 SESSION BY SESSION - FEEDBACK TRACKING 78 How was this meeting? 79 Session Rating Scale (SRS V.3.0) 80 REVIEW 81 Strengths and Difficulties Questionnaire P 3/4 Follow- up 83 Strengths and Difficulties Questionnaire P 4-16 Follow- up 85 RCADS 87 CHI Experience of service questionnaire Contents -5

6 87 PRACTITIONER RESOURCES 88 PRACTITIONER FORMS 89 Demographics 90 Current View 91 Education, Employment or Training 92 Goal progress chart 93 Session Details 94 Interventions and Medications 95 PRACTITIONER SCORING AIDS 96 SDQ SCORING AIDS 97 SDQ Scoring aid - Child/ Parent/Carer report 99 RCADS SCORING AIDS 100 RCADs Scoring aid - Creating sub scales for child self report 102 RCADs Scoring aid - Creating sub scales for parent report 104 CLINICAL BANDS 105 CLINICAL BANDS ASSESSMENT- CHILD 106 Clinical Bands - Self Report : 8 to 10 year olds 107 Clinical Bands - Self Report : 11 to 12 year olds 108 Clinical Bands -Self Report : 13 to 14 year olds 109 Clinical Bands - Self Report : 15 to 16 year olds 110 Clinical Bands - Self Report : 17 to 18 year olds 111 CLINICAL BANDS ASSESSMENT- PARENT/CARER 112 Clinical Bands - Parent of Child age: 3 to 4 years 113 Clinical Bands - Parent of Child age: 4 to 8 years 114 Clinical Bands - Parent of Child age: 8 to 10 years 115 Clinical Bands - Parent of Child age: 11 to 12 years 119 CLINICAL BANDS SESSION BY SESSION- CHILD 120 Clinical Bands - Self Report : 8 to 10 year olds 121 Clinical Bands - Self Report : 11 to 12 year olds 122 Clinical Bands -Self Report : 13 to 14 year olds 123 Clinical Bands - Self Report : 15 to 16 year olds 124 Clinical Bands - Self Report : 17 to 18 year olds 125 Clinical Bands - Self Report : adult CLINICAL BANDS SESSION BY SESSION- PARENT/CARER 127 Clinical Bands - Parent of Child age: 8 to 10 years 128 Clinical Bands - Parent of Child age: 11 to 12 years 129 Clinical Bands - Parent of Young Person age: 13 to 14 years 130 Clinical Bands - Parent of Young Person age: 15 to 16 years 131 Clinical Bands - Parent of Young Person age: 17 to 18 years Contents -6

7 WELCOME

8 Welcome The Children and Young People s Improving Access to Psychological Therapies Tracking Outcomes Resource Pack This pack contains: Copies of measures for use at initial assessment, session by session and at review. Guidance on scoring measures Information on interpreting the scores in terms of clinical bands (where appropriate) Consent forms (to be completed by relevant family members when questionnaire first sent out or at first meeting as deemed most relevant) All forms can be printed and copied freely. Note on tracking change and experience for children, young people and families The aim is to help clinicians understand and track change from the point of view of those they are working with, in order to help guide clinical interventions. The set of tools are chosen to provide information that can complement other information, and service users feedback, gained through clinical conversations. Evidence shows us that if we get our approach to monitoring outcomes right, children and young people feel more involved in their treatment and together we achieve better outcomes. The role and attitude of the therapist when giving children and young people or their parents these tools is critically important this is more than an add-on to your session. The forms for children, young people and parents in this pack are designed to be completed direct by service users but can also be used as prompts or aids for discussion and completed in conversation in the session (e.g. in particular the feedback on sessions questions) and the form filled out afterwards to capture the scores. This approach was developed by the Outcomes and Evaluation Group (December 2011) and will be reviewed by them in July This pack should be used along the lines laid out by the Outcomes and Evaluation Group Briefing Note (December 2011) and in conjunction with the CYP IAPT Outcomes Orientated Practice Group (CO-OP) guide and other guidelines on the CYP IAPT web pages We welcome any comments on the approach or feedback as to how you have found it please iapt@dh.gsi.gov.uk. Miranda Wolpert Chair of Outcome and Evaluation Group CYP IAPT February 2012 Overview Copyright

9 Membership of Outcomes and Evaluation Task and Finish Group (OEG) With brief information on key relevant expertise Dr Miranda Wolpert (Chair) CAMHS outcomes, data collection and analysis (National Informatics Advisor CYP IAPT) Professor David Clark Adult IAPT implementation and data analysis (National Informatics Advisor Adult IAPT) Margaret Oates Adult IAPT data collection and collation expertise David Wells Child and maternity data management and reporting Bill Badham Involvement of young people expertise Dr Duncan Law Clinical and outcome monitoring expertise in CAMHS Dr Margaret Murphy Clinical and outcome monitoring expertise in CAMHS Dr Jessica Deighton CAMHS measure review and psychometric analysis expertise Dr Ann York Expertise in Payment by Results currency development work and CAPA/service improvement in CAMHS Amandeep Hothi Voluntary sector expertise Kathryn Pugh Project manager for Children & Young People s IAPT Dr Paul Wilkinson expertise in session by session monitoring in Cambridge IAPT Claire Maguire Expertise in session by session monitoring in Bury IAPT and commissioning Damian Hart Expertise in commissioning Professor Paul Stallard expertise in CBT and CAMHS Professor Stephen Scott Expertise in conduct disorder and parenting Dr Andy Fugard Psychometrics Kevin Mullins National IAPT Programme Lead Dr Raphael Kelvin DH advisor on CAMHS Overview Copyright

10 Using information from clinical tools to improve clinical practice Overview of Measures All measure can be completed by parent only, young person only or both as judged relevant Assessment Measures: MEASURES Notes SDQ RCADS Seek consent to share data- either at first meeting or with initial letter Session-by-session Measures: MEASURES Notes Goals tracking General wellbeing tracking Symptom tracking Impact tracking Feedback tracking Use review of goals to check progress against agreed focus Use Outcomes Rating Scale to track general wellbeing Use one of the brief session specific measures as relevant to the specific difficulties being focused on NB 90% of all cases must have at least two time points of symptom tracking data from same category of respondent by time of case closure Use how are you doing measure instead of symptom tracking only if none of symptom measures above are suitable Use four questions or session rating scale towards end of meeting to discuss how the meeting was experienced by those present Review Measures: MEASURES Notes SDQ RCADS Completed every six months or as service protocol demands (some services may choose to do more or less frequently) CHI- ESQ Overview Copyright

11 Some Do s and Don ts of using clinical outcome tools 1 DO Make sure you have the questionnaires you need, ready before the session 2 DO Always explain why you are asking anyone to fill out a questionnaire 3 DO Look at the answers 4 DO Discuss the answers with service users 5 DO Share the information in supervision 6 DO Always use information from outcomes in conjunction with other clinical information 1 Don t Give out a questionnaire if you think the person doesn t understand why they are being asked to complete them 2 Don t Give out any outcome measure if you don t understand why you are using it 3 Don t Use the tools if the service users is too distressed 4 Don t See the numbers generated from outcome tools as an absolute fact 5 Don t See your clinical judgement as an absolute fact Taken from CO-OP guide V1.3 Feb 2012 p.16 Overview Copyright

12 CONSENT TO SHARE INFORMATION

13 Gaining Consent to share data: information for practitioners The CYP IAPT project has agreed an opt in approach to data sharing. This means asking children, young people or their parents/guardians as relevant, for permission to share their data. This permission covers: answers to questionnaires and some key personal details such as name and address, so that different pieces of information can be linked to allow meaningful analysis (e.g. a child s questionnaire responses can be linked to the number of sessions they were seen for and the sort of treatment they received). Before we analyse the data we will delete all personal details and only use the anonymised data for analysis and reporting The approach we are taking We have been advised to follow the process used for gaining consent for use of Patient Reported Outcomes Measures in elective surgery. This involves asking the first time a questionnaire is completed for permission to use the data from this and subsequent questionnaires. Who gives consent? If a young person is over the age of 16 they can give independent consent without parental input unless there are exceptional circumstances (such as where they are deemed unable to make independent decisions for some reason) If a young person is under the age of 16 but judged Gillick competent i.e. able to understand and retain the information about the decision they are making and can weigh up and use this information in coming to their decision, then they too can legal give consent without parent or guardian authorization. If a young person is under the age of 16 and not judged Gillick competent, i.e. not able to understand and retain the information about the decision they are making and can weigh up and use this information in coming to their decision, then parent or guardian authorization is required Who completes the form? There are two consent forms- one for young people and one for their parents/guardians. Only ONE needs to be completed. Please ask for the ONE to be completed that you deem relevant If the young person is judged Gillick competent and completes the young person form, but they and you would like the parent to sign the form also that is fine just ask the parent/guardian to add their signature to the bottom of the form for young people. If the parent is the one giving authorization but you and they feel it makes sense for the non-gillick competent child to sign that is also fine they can add their signature on the form for parents. Participation is voluntary If authorization is not given or withdrawn at any time please ensure this is recorded on your relevant database so that the information in question can be excluded from data sharing. 1/1 Consent form Practitioner Copyright

14 Consent to share information: Improving Access to Psychological Therapy for Children & Young People During treatment, you will be asked to complete questionnaires about how you feel and how much progress you are making towards achieving treatment goals. Your therapist will regularly check these with you to make sure they are helping the best they can. Our request We are asking your permission to use answers to these questionnaires to collect information about the quality of the services provided for children, young people and their families Our promise Nationally, we will report only group information, for instance how many people with particular problems have recovered by the end of treatment. It will not be possible to identify you personally from these analyses and reports. By signing this consent form you are agreeing that: Your personal details and questionnaire responses will be held securely by MegaNexus who are providing secure data storage for the Improving Access to Psychological Therapies for Children and Young People. All the information will be handled securely (no unauthorized person can see it). Any identifying information, such as your name, address etc, will be removed before analysis and before any publication. This anonymised data will be used by The CAMHS Outcomes Research Consortium (CORC) who are analysing the data and may be used by other research groups to help make services as good as they can be. No one involved in the project will release your personal information unless required by law or where there is a clear overriding public interest. Your participation is voluntary You may withdraw your consent for this information to be shared up to the point at which data are analysed and personal details removed. Please talk to the person working with you if you have any concerns or queries I agree for my information to be part of the database for the Children and Young People Improving Access to Psychological Therapies Project Yes OR No (please circle) Name: Signature: Date 1/1 Consent form Child/Young Person CAMHS EBPU

15 Parental Consent to share information: Improving Access to Psychological Therapy for Children & Young People During treatment, you and your child may be asked to complete questionnaires about how you and they feel and how much progress you are making towards achieving treatment goals. The therapist will regularly check these with you to make sure they are helping the best they can. Our request We are asking your permission to use answers to these questionnaires to collect information about the quality of the services provided for children, young people and their families Our promise Nationally, we will report only group information, for instance how many people with particular problems have recovered by the end of treatment. It will not be possible to identify you or your child personally from these analyses and reports. By signing this consent form you are agreeing that: Your child s personal details and questionnaire responses will be held securely by MegaNexus who are providing secure data storage for the Improving Access to Psychological Therapies for Children and Young People. All the information will be handled securely (no unauthorized person can see it). Any identifying information, such as your child s name and address etc will be removed before analysis and before any publication. This anonymised data will be used by The CAMHS Outcomes Research Consortium (CORC) who are analysing the data and may be used by other research groups to help make services as good as they can be. No one involved in the project will release your personal information unless required by law or where there is a clear overriding public interest. Your participation is voluntary You may withdraw your consent for this information to be shared up to the point at which data are analysed and personal details removed. Please talk to the person working with you if you have any concerns or queries. I agree for my child s information to be part of the database for the Children and Young People Improving Access to Psychological Therapies Project Yes OR No (please circle) Name: Signature: Date 1/1 Consent form Parent/Carer CAMHS EBPU

16 CHILD/ YOUNG PERSON MEASURES 17 ASSESSMENT 18 Strengths and Difficulties Questionnaire S RCADS 22 SESSION BY SESSION - GOAL OR GLOBAL TRACKING 23 Goal progress chart 24 Outcome Rating Scale (ORS) 25 Child Outcome Rating Scale (CORS) 26 Young Child Outcome Rating Scale (YCORS) 27 SESSION BY SESSION - SYMPTOM TRACKING 28 How are things? 38 SESSION BY SESSION - IMPACT TRACKING 39 How are you doing? 40 SESSION BY SESSION - FEEDBACK TRACKING 41 How was this meeting? 42 Session Rating Scale (SRS V.3.0) 43 Child Session Rating Scale (CSRS) 44 Young Child Session Rating Scale (YCSRS) 45 Group Session Rating Scale (GDRC) 46 Child Group Session Rating Scale (CGSRS) 47 REVIEW 48 Strengths and Difficulties Questionnaire S11-17 Follow-up 50 RCADS 52 CHI Experience of Service Questionnaire Day Services (9-11) 54 CHI Experience of Service Questionnaire Day Services (12-18)

17 CHILD/ YOUNG PERSON MEASURES ASSESSMENT

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20 RCADS NHS ID: Child/ Young Person s NAME: h Date: / / 20 Time: Please put a circle around the word that shows how often each of these things happens to you. There are no right or wrong answers. 1 I worry about things 2 I feel sad or empty 3 When I have a problem, I get a funny feeling in my stomach 4 I worry when I think I have done poorly at something 5 I would feel afraid of being on my own at home 6 Nothing is much fun anymore 7 I feel scared when I have to take a test 8 I feel worried when I think someone is angry with me 9 I worry about being away from my parent 10 I am bothered by bad or silly thoughts or pictures in my mind 11 I have trouble sleeping 12 I worry that I will do badly at my school work I worry that something awful will happen to someone in my family I suddenly feel as if I can t breathe when there is no reason for this 15 I have problems with my appetite 16 I have to keep checking that I have done things right (like the switch is off, or the door is locked) 17 I feel scared if I have to sleep on my own 18 I have trouble going to school in the mornings because I feel nervous or afraid 19 I have no energy for things 20 I worry I might look foolish 1/2 RCADS C hild/young Person 20 Questions 2003 Bruce F. Chorpita,Ph.D

21 21 I am tired a lot 22 I worry that bad things will happen to me 23 I can t seem to get bad or silly thoughts out of my head 24 When I have a problem, my heart beats really fast 25 I cannot think clearly 26 I suddenly start to tremble or shake when there is no reason for this 27 I worry that something bad will happen to me 28 When I have a problem, I feel shaky 29 I feel worthless 30 I worry about making mistakes 31 I have to think of special thoughts (like numbers or words) to stop bad things from happening 32 I worry what other people think of me 33 I am afraid of being in crowded places (like shopping centers, the movies, buses, busy playgrounds) 34 All of a sudden I feel really scared for no reason at all 35 I worry about what is going to happen 36 I suddenly become dizzy or faint when there is no reason for this 37 I think about death 38 I feel afraid if I have to talk in front of my class 39 My heart suddenly starts to beat too quickly for no reason 40 I feel like I don t want to move I worry that I will suddenly get a scared feeling when there is nothing to be afraid of I have to do some things over and over again (like washing my hands, cleaning or putting things in a certain order) I feel afraid that I will make a fool of myself in front of people I have to do some things in just the right way to stop bad things from happening 45 I worry when I go to bed at night 46 I would feel scared if I had to stay away from home overnight 47 I feel restless 2/2 RCADS C hild/young Person 21 Questions 2003 Bruce F. Chorpita, Ph.D

22 CHILD/ YOUNG PERSON MEASURES SESSION BY SESSION - GOAL OR GLOBAL TRACKING

23 Goal progress chart Goal N o You can turn this chart on its side for a quick look at progress over the sessions. GOAL: Session Date Today I would rate progress to this goal: (please circle the appropriate number below) Remember a score of zero means no progress has been made towards a goal, a score of ten means a goal has been reached fully, and a score of five is exactly half way between the two Who agreed this goal (tick below): Child/young person Family members Practitioner Other (please specify) : NHS ID: Service allocated case ID 1/1 Goal Progress Chart Child/Young Person 23 Duncan Law, Hertfordshire Partnership NHS

24 Outcome Rating Scale (ORS) (Ages 13 to Adult) Name Age (Yrs): Session # Date: Who is filling out this form? Please check one: Self Other If other, what is your relationship to this person? Looking back over the last week, including today, help us understand how you have been feeling by rating how well you have been doing in the following areas of your life, where marks to the left represent low levels and marks to the right indicate high levels. If you are filling out this form for another person, please fill out according to how you think he or she is doing. Individually (Personal well-being) SCORING Each line is 10cm. Interpersonally (Family, close relationships) Socially (Work, school, friendships) Score with ruler e.g. 3.5cm = score of 3.5. Write the scores for each of the four lines here in the margin. Add the four scores for a total score. Overall (General sense of well-being) Plot overall score on the graph The information on this page is for illustration purposes only. Please go to and follow the link for Performance Metrics to download the measure , Scott D. Miller and Barry L. Duncan

25 Child Outcome Rating Scale (CORS) (Ages 6 to 12) Name Age (Yrs): Session # Date: Who is filling out this form? Please check one: Child Caretaker If caretaker, what is your relationship to this child? How are you doing? How are things going in your life? Please make a mark on the scale to let us know. The closer to the smiley face, the better things are. The closer to the frowny face, things are not so good. If you are a caretaker filling out this form, please fill out according to how you think the child is doing. Me (How am I doing?) SCORING Each line is 10cm. Family (How are things in my family?) School (How am I doing at school?) Everything (How is everything going?) Score with ruler e.g. 3.5cm = score of 3.5. Write the scores for each of the four lines here in the margin. Add the four scores for a total score. Plot overall score on the graph The information on this page is for illustration purposes only. Please go to and follow the link for Performance Metrics to download the measure , Barry L. Duncan, Scott D. Miller, & Jacqueline A. Sparks

26 , Barry L. Duncan, Scott D. Miller, Andy Huggins, and Jacqueline A. Sparks

27 CHILD/ YOUNG PERSON MEASURES SESSION BY SESSION - SYMPTOM TRACKING

28 How are things? Date: / / 20 Time: h ' Session N o Please put a circle around the word that shows how often each of these things happen to you. There are no right or wrong answers I feel sad or empty 2 Nothing is much fun anymore 3 I have trouble sleeping 4 I have problems with my appetite 5 I have no energy for things 6 I am tired a lot 7 I cannot think clearly 8 I feel worthless 9 I feel like I don t want to move 10 I feel restless SUM: NHS ID: Service allocated case ID 1/1 Depression/ Low Mood Child/Young Person 28 Questions 2003 Bruce F. Chorpita, Ph.D

29 How are things? Date: / / 20 Time: h ' Session N o Please put a circle around the word that shows how often each of these things happen to you. There are no right or wrong answers I would feel afraid of being on my own at home 2 I worry about being away from my parents 3 I feel scared if I have to sleep on my own 4 5 I have trouble going to school in the mornings because I feel nervous or afraid I am afraid of being in crowded places (shopping centres, the movies, buses, busy playgrounds) 6 I worry when I go to bed at night 7 I would feel scared if I had to stay away from home overnight SUM: NHS ID: Service allocated case ID 1/1 Anxious Away from Home (Separation Anxiety) Child/Young Person 29 Questions 2003 Bruce F. Chorpita, Ph.D

30 How are things? Date: / / 20 Time: h ' Session N o Please put a circle around the word that shows how often each of these things happen to you. There are no right or wrong answers I worry when I think I have done poorly at something 2 I feel scared when I have to take a test 3 I feel worried when I think someone is angry with me 4 I worry that I will do badly at my school work 5 I worry I might look foolish 6 I worry about making mistakes 7 I worry what other people think of me 8 I feel afraid if I have to talk in front of my class 9 I feel afraid that I will make a fool of myself in front of people SUM: NHS ID: Service allocated case ID 1/1 Anxious in Social Situations (Social Anxiety or Phobia) Child/Young Person 30 Questions 2003 Bruce F. Chorpita, Ph.D

31 How are things? Date: / / 20 Time: h ' Session N o Please put a circle around the word that shows how often each of these things happen to you. There are no right or wrong answers I worry about things 2 I worry that something awful will happen to someone in my family 3 I worry that bad things will happen to me 4 I worry that something bad will happen to me 5 I worry about what is going to happen 6 I think about death SUM: NHS ID: Service allocated case ID 1/1 Anxious Generally (Generalized Anxiety) Child/Young Person 31 Questions 2003 Bruce F. Chorpita, Ph.D

32 How are things? Date: / / 20 Time: h ' Session N o Please put a circle around the word that shows how often each of these things happen to you. There are no right or wrong answers I get bothered by bad or silly thoughts or pictures in my mind 2 I have to keep checking that I have done things right (like the switch is off, or the door is locked) 3 I can t seem to get bad or silly thoughts out of my head I have to think of special thoughts (like numbers or words) to stop bad things from happening I have to do some things over and over again (like washing my hands, cleaning or putting things in a certain order) I have to do some things in just the right way to stop bad things from happening SUM: NHS ID: Service allocated case ID 1/1 Compelled to do or Think Things (OCD) Child/Young Person 32 Questions 2003 Bruce F. Chorpita, Ph.D

33 How are things? Date: / / 20 Time: h ' Session N o Please put a circle around the word that shows how often each of these things happen to you. There are no right or wrong answers When I have a problem, I get a funny feeling in my stomach 2 I suddenly feel as if I can t breathe when there is no reason for this 3 When I have a problem, my heart beats really fast 4 I suddenly start to tremble or shake when there is no reason for this 5 When I have a problem, I feel shaky 6 All of a sudden I feel really scared for no reason at all 7 I suddenly become dizzy or faint when there is no reason for this 8 My heart suddenly starts to beat too quickly for no reason 9 I worry that I will suddenly get a scared feeling when there is nothing to be afraid of SUM: NHS ID: Service allocated case ID 1/1 Panic Child/Young Person 33 Questions 2003 Bruce F. Chorpita, Ph.D

34 How are things? Date: / / 20 Time: h ' Session N o Below is a list of comments made by people after stressful life events. Please mark each item showing how frequently these comments were true for you during the past seven days. If they did not occur during that time please mark the not at all box. Frequency during the last week: I thought about it when I didn t mean to Not at all Rarely Sometimes Often 2 I tried to remove it from memory Not at all Rarely Sometimes Often 3 I had waves of strong feelings about it Not at all Rarely Sometimes Often 4 I stayed away from reminders of it Not at all Rarely Sometimes Often 5 I tried not to talk about it Not at all Rarely Sometimes Often 6 Pictures about it popped into my mind Not at all Rarely Sometimes Often 7 Other things kept making me think about it Not at all Rarely Sometimes Often 8 I tried not to think about it Not at all Rarely Sometimes Often SUM: NHS ID: Service allocated case ID 1/1 Disturbed by Traumatic Event (PTSD) Child/Young Person 34 Questions 1995 Dyregrov and Yule

35 How are things? Date: / / 20 Time: h ' Session N o Below is a questionnaire which is going to ask you how you feel. There are no right or wrong answers. You should just pick the answer which is best for you. For example, we might ask I feel happy, and then you will have to mark one of the options that say Never, Sometimes or Always I get very angry Never Sometimes Always 2 I lose my temper Never Sometimes Always 3 I hit out when I am angry Never Sometimes Always 4 I do things to hurt people Never Sometimes Always 5 I am calm * Always Sometimes Never 6 I break things on purpose Never Sometimes Always 7 I bully others Never Sometimes Always *This item needs to be scored in reverse, i.e. Always =2, Sometimes=1, Never=0 Clinical banding is based on scoring of first 6 items only. SUM: NHS ID: Service allocated case ID 1/1 Behavioural Difficulties Child/Young Person CAMHS EBPU

36 How are things? Date: / / 20 Time: h ' Session N o Over the last 2 weeks, how often have you been bothered by any of the following problems? Over the last 2 weeks, how often have you been bothered by any of the following problems? Little interest or pleasure in doing things Not at all Several days 2 Feeling down, depressed, or hopeless Not at all Several days 3 Trouble falling or staying asleep, or sleeping too much Not at all Several days 4 Feeling tired or having little energy Not at all Several days 5 Poor appetite or overeating Not at all Several days More than half the days More than half the days More than half the days More than half the days More than half the days Nearly every day Nearly every day Nearly every day Nearly every day Nearly every day 6 Feeling bad about yourself or that you are a failure or have let yourself or your family down Not at all Several days More than half the days Nearly every day 7 Trouble concentrating on things, such as reading the newspaper or watching television Not at all Several days More than half the days Nearly every day 8 Moving or speaking so slowly that other people could have noticed/ Or the opposite being so fidgety or restless that you have been moving around a lot more than usual Not at all Several days More than half the days Nearly every day 9 Thoughts that you would be better off dead or of hurting yourself in some way Not at all Several days More than half the days Nearly every day SUM: NHS ID: Service allocated case ID 1/1 PHQ-9 Young Person 36 Questions 2003 Bruce F. Chorpita, Ph.D

37 How are things? Date: / / 20 Time: h ' Session N o Over the last 2 weeks, how often have you been bothered by any of the following problems? Over the last 2 weeks, how often have you been bothered by any of the following problems? Feeling nervous, anxious or on edge Not at all Several days 2 Not being able to stop or control worrying Not at all Several days 3 Worrying too much about different things Not at all Several days 4 Trouble relaxing Not at all Several days 5 Being so restless that it is hard to sit still Not at all Several days 6 Becoming easily annoyed or irritable Not at all Several days 7 Feeling afraid as if something awful might happen Not at all Several days More than half the days More than half the days More than half the days More than half the days More than half the days More than half the days More than half the days Nearly every day Nearly every day Nearly every day Nearly every day Nearly every day Nearly every day Nearly every day SUM: NHS ID: Service allocated case ID 1/1 GAD-7 Young Person 37 Questions 2003 Bruce F. Chorpita, Ph.D

38 CHILD/ YOUNG PERSON MEASURES SESSION BY SESSION - IMPACT TRACKING

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40 CHILD/ YOUNG PERSON MEASURES SESSION BY SESSION - FEEDBACK TRACKING

41 How was this meeting? Date: / / 20 Time: h ' Session N o Did you feel listened to? Not at all Only a little Somewhat Quite a bit Totally Did you talk about what you wanted to talk about? Did you understand the things said in the meeting? Did you feel the meeting gave you ideas for what to do? Not at all Only a little Somewhat Quite a bit Totally Not at all Only a little Somewhat Quite a bit Totally Not at all Only a little Somewhat Quite a bit Totally Who gave this feedback (tick below): Child/young person Mother Father Professional Other (please specify) : SUM: NHS ID: Service allocated case ID 1/1 Session Feedback Child/Young Person 41 Questions 2003 Bruce F. Chorpita, Ph.D

42 Session Rating Scale (SRS V.3.0) (Ages 13 to Adult) Name Age (Yrs): Session # Date: Please rate today s session by placing a mark on the line nearest to the description that best fits your experience. Relationship I did not feel heard, understood, and respected. We did not work on or talk about what I wanted to work on and talk about. Goals and Topics Approach or Method I felt heard, understood, and respected. We worked on and talked about what I wanted to work on and talk about. The therapist s approach is not a good fit for me. There was something missing in the session today. Overall The therapist s approach is a good fit for me. Overall, today s session was right for me. The information on this page is for illustration purposes only. Please go to and follow the link for Performance Metrics to download the measure , Scott D. Miller, Barry L. Duncan, & Lynn Johnson

43 Child Session Rating Scale (CSRS) (Ages 6 to 12) Name Age (Yrs): Session # Date: How was our time together today? Please put a mark on the lines below to let us know how you feel. did not always listen to me. Listening listened to me. What we did and talked about was not really that important to me. I did not like what we did today. I wish we could do something different How Important What We Did Overall What we did and talked about were important to me I liked what we did today. I hope we do the same kind of things next time. The information on this page is for illustration purposes only. Please go to and follow the link for Performance Metrics to download the measure , Barry L. Duncan, Scott D. Miller, & Jacqueline A. Sparks

44 , Barry L. Duncan, Scott D. Miller, Andy Huggins, and Jacqueline A. Sparks

45 Group Session Rating Scale (GDRC) (Ages 13 to Adult) Name Age (Yrs): Session # Date: Please rate today s group by placing a mark on the line nearest to the description that best fits your experience. I did not feel understood, respected, and/ or accepted by the leader and/or the group. Relationship I felt understood, respected, and accepted by the leader and the group. We did not work on or talk about what I wanted to work on and talk about. The leader and/ or the group s approach is a not a good fit for me. There was something missing in group today I did not feel like a part of the group. Goals and Topics Approach or Method Overall We worked on and talked about what I wanted to work on and talk about. The leader and group s approach is a good fit for me. Overall, today s group was right for me I felt like a part of the group. The information on this page is for illustration purposes only. Please go to and follow the link for Performance Metrics to download the measure , Barry L. Duncan and Scott D. Miller

46 Child Group Session Rating Scale (CGSRS) (Ages 6 to 12) Name Age (Yrs): Session # Date: How was our group today? Please put a mark on the lines below to let us know how you feel. The leader or group did not listen to me or like me. Listening The leader and group listened to me and liked me. We did not talk about or do important things. How Important We talked about and did important things. I did not like what we did today. What We Did I liked what we did today. Today was not good for me I did not feel like a part of this group. Overall Today was good for me I felt like a part of this group. The information on this page is for illustration purposes only. Please go to and follow the link for Performance Metrics to download the measure , Barry L. Duncan, Scott D. Miller, Jacqueline A. Sparks, & John J, Murphy

47 CHILD/ YOUNG PERSON MEASURES REVIEW

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50 RCADS NHS ID: Child/ Young Person s NAME: h Date: / / 20 Time: Please put a circle around the word that shows how often each of these things happens to you. There are no right or wrong answers. 1 I worry about things 2 I feel sad or empty 3 When I have a problem, I get a funny feeling in my stomach 4 I worry when I think I have done poorly at something 5 I would feel afraid of being on my own at home 6 Nothing is much fun anymore 7 I feel scared when I have to take a test 8 I feel worried when I think someone is angry with me 9 I worry about being away from my parent 10 I am bothered by bad or silly thoughts or pictures in my mind 11 I have trouble sleeping 12 I worry that I will do badly at my school work I worry that something awful will happen to someone in my family I suddenly feel as if I can t breathe when there is no reason for this 15 I have problems with my appetite 16 I have to keep checking that I have done things right (like the switch is off, or the door is locked) 17 I feel scared if I have to sleep on my own 18 I have trouble going to school in the mornings because I feel nervous or afraid 19 I have no energy for things 20 I worry I might look foolish 1/2 RCADS C hild/young Person 50 Questions 2003 Bruce F. Chorpita, Ph.D

51 21 I am tired a lot 22 I worry that bad things will happen to me 23 I can t seem to get bad or silly thoughts out of my head 24 When I have a problem, my heart beats really fast 25 I cannot think clearly 26 I suddenly start to tremble or shake when there is no reason for this 27 I worry that something bad will happen to me 28 When I have a problem, I feel shaky 29 I feel worthless 30 I worry about making mistakes 31 I have to think of special thoughts (like numbers or words) to stop bad things from happening 32 I worry what other people think of me 33 I am afraid of being in crowded places (like shopping centers, the movies, buses, busy playgrounds) 34 All of a sudden I feel really scared for no reason at all 35 I worry about what is going to happen 36 I suddenly become dizzy or faint when there is no reason for this 37 I think about death 38 I feel afraid if I have to talk in front of my class 39 My heart suddenly starts to beat too quickly for no reason 40 I feel like I don t want to move I worry that I will suddenly get a scared feeling when there is nothing to be afraid of I have to do some things over and over again (like washing my hands, cleaning or putting things in a certain order) I feel afraid that I will make a fool of myself in front of people I have to do some things in just the right way to stop bad things from happening 45 I worry when I go to bed at night 46 I would feel scared if I had to stay away from home overnight 47 I feel restless 2/2 RCADS C hild/young Person 51 Questions 2003 Bruce F. Chorpita, Ph.D

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56 PARENT/ CARER MEASURES 56 ASSESSMENT 57 Strengths and Difficulties Questionnaire P 3/4 59 Strengths and Difficulties Questionnaire P RCADS 63 SESSION BY SESSION - GOAL OR GLOBAL TRACKING 64 Goal progress chart 65 Outcome Rating Scale (ORS) 66 SESSION BY SESSION - SYMPTOM TRACKING 67 How are things? 68 How are things? 74 SESSION BY SESSION - IMPACT TRACKING 75 How is your child doing? 76 SESSION BY SESSION - FEEDBACK TRACKING 77 How was this meeting? 78 Session Rating Scale (SRS V.3.0) 79 REVIEW 80 Strengths and Difficulties Questionnaire P 3/4 Follow- up 82 Strengths and Difficulties Questionnaire P 4-16 Follow- up 84 RCADS 86 CHI Experience of service questionnaire

57 PARENT/ CARER MEASURES ASSESSMENT

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62 RCADS NHS ID: Child/ Young Person s NAME: Relationship to Child/Young Person : h Date: / / 20 Time: Please put a circle around the word that shows how often each of these things happens to your child. There are no right or wrong answers. 1 My child worries about things 2 My child feels sad or empty 3 4 When my child has a problem, he/she gets a funny feeling in his/her stomach My child worries when he/she thinks he/she has done poorly at something 5 My child feels afraid of being alone at home 6 Nothing is much fun for my child anymore 7 My child feels scared when taking a test 8 My child worries when he/she thinks someone is angry with him/her 9 My child worries about being away from me 10 My child is bothered by bad or silly thoughts or pictures in his/her mind 11 My child has trouble sleeping 12 My child worries about doing badly at school work My child worries that something awful will happen to someone in the family My child suddenly feels as if he/she can t breathe when there is no reason for this 15 My child has problems with his/her appetite 16 My child has to keep checking that he/she has done things right (like the switch is off, or the door is locked) 17 My child feels scared to sleep on his/her own 18 My child has trouble going to school in the mornings because of feeling nervous or afraid 19 My child has no energy for things 20 My child worries about looking foolish 1/2 RCADS Parent/Carer 62 Questions 2003 Bruce F. Chorpita, Ph.D

63 21 My child is tired a lot My child worries that bad things will happen to him/her My child can t seem to get bad or silly thoughts out of his/her head When my child has a problem, his/her heart beats really fast 25 My child cannot think clearly My child suddenly starts to tremble or shake when there is no reason for this My child worries that something bad will happen to him/her 28 When my child has a problem, he/she feels shaky 29 My child feels worthless 30 My child worries about making mistakes 31 My child has to think of special thoughts (like numbers or words) to stop bad things from happening 32 My child worries what other people think of him/her My child is afraid of being in crowded places (like shopping centers, the movies, buses, busy playgrounds) All of a sudden my child will feel really scared for no reason at all 35 My child worries about what is going to happen 36 My child suddenly becomes dizzy or faint when there is no reason for this 37 My child thinks about death My child feels afraid if he/she has to talk in front of the class My child s heart suddenly starts to beat too quickly for no reason 40 My child feels like he/she doesn t want to move My child worries that he/she will suddenly get a scared feeling when there is nothing to be afraid of My child has to do some things over and over again (like washing hands, cleaning, or putting things in a certain order) My child feels afraid that he/she will make a fool of him/herself in front of people My child has to do some things in just the right way to stop bad things from happening 45 My child worries when in bed at night 46 My child would feel scared if he/she had to stay away from home overnight 47 My child feels restless 2/2 RCADS Parent/Carer 63 Questions 2003 Bruce F. Chorpita, Ph.D

64 PARENT/ CARER MEASURES SESSION BY SESSION - GOAL OR GLOBAL TRACKING

65 Goal progress chart Goal N o You can turn this chart on its side for a quick look at progress over the sessions. GOAL: Session Date Today I would rate progress to this goal: (please circle the appropriate number below) Remember a score of zero means no progress has been made towards a goal, a score of ten means a goal has been reached fully, and a score of five is exactly half way between the two Who agreed this goal (tick below): Child/young person Family members Practitioner Other (please specify) : NHS ID: Service allocated case ID 1/1 Goal Progress Chart Parent/Carer 65 Duncan Law, Hartfordshire Partnership NHS

66 Outcome Rating Scale (ORS) (Ages 13 to Adult) Name Age (Yrs): Session # Date: Who is filling out this form? Please check one: Self Other If other, what is your relationship to this person? Looking back over the last week, including today, help us understand how you have been feeling by rating how well you have been doing in the following areas of your life, where marks to the left represent low levels and marks to the right indicate high levels. If you are filling out this form for another person, please fill out according to how you think he or she is doing. Individually (Personal well-being) SCORING Each line is 10cm. Interpersonally (Family, close relationships) Socially (Work, school, friendships) Overall (General sense of well-being) Score with ruler e.g. 3.5cm = score of 3.5. Write the scores for each of the four lines here in the margin. Add the four scores for a total score. Plot overall score on the graph. The information on this page is for illustration purposes only. Please go to and follow the link for Performance Metrics to download the measure , Scott D. Miller and Barry L. Duncan

67 PARENT/ CARER MEASURES SESSION BY SESSION - SYMPTOM TRACKING

68 How are things? Session N o Date: day, month, year. Time: hour, minutes. Please put a circle around the word that shows how often each of these things happen to your child. There are no right or wrong answers My child feels sad or empty 2 Nothing is much fun for my child anymore 3 My child has trouble sleeping 4 My child has problems with his/her appetite 5 My child has no energy for things 6 My child is tired a lot 7 My child cannot think clearly 8 My child feels worthless 9 My child feels like he/she doesn t want to move 10 My child feels restless SUM: Relationship to child/ young person (tick below): Mother Father Other (please specify) : NHS ID: Service allocated case ID 1/1 Depression/Low Mood Parent/Carer 68 Questions 2003 Bruce F. Chorpita, Ph.D

69 How are things? Session N o Date: day, month, year. Time: hour, minutes. Please put a circle around the word that shows how often each of these things happen to your child. There are no right or wrong answers My child feels afraid of being alone at home 2 My child worries about being away from me 3 My child feels scared to sleep on his/her own 4 5 My child has trouble going to school in the mornings because of feeling nervous or afraid My child is afraid of being in crowded places (like shopping centers, the movies, buses, busy playgrounds) 6 My child worries when in bed at night 7 My child would feel scared if he/she had to stay away from home overnight SUM: Relationship to child/ young person (tick below): Mother Father Other (please specify) : NHS ID: Service allocated case ID 1/1 Anxious Away from Home(Separation Anxiety) Parent/Carer 69 Questions 2003 Bruce F. Chorpita, Ph.D

70 How are things? Session N o Date: day, month, year. Time: hour, minutes. Please put a circle around the word that shows how often each of these things happen to your child. There are no right or wrong answers My child worries when he/she thinks he/she has done poorly at something 2 My child feels scared when taking a test 3 My child worries when he/she thinks someone is angry with him/her 4 My child worries about doing badly at school work 5 My child worries about looking foolish 6 My child worries about making mistakes 7 My child worries what other people think of him/her 8 My child feels afraid if he/she have to talk in front of the class 9 My child feels afraid that he/she will make a fool of him/ herself in front of people SUM: Relationship to child/ young person (tick below): Mother Father Other (please specify) : NHS ID: Service allocated case ID 1/1 Anxiety in Social Situations (Social Anxiety or Phobia) Parent/Carer 70 Questions 2003 Bruce F. Chorpita, Ph.D

71 How are things? Session N o Date: day, month, year. Time: hour, minutes. Please put a circle around the word that shows how often each of these things happen to your child. There are no right or wrong answers My child worries about things 2 My child worries that something awful will happen to someone in the family 3 My child worries that bad things will happen to him/her 4 My child worries that something bad will happen to him/her 5 My child worries about what is going to happen 6 My child thinks about death SUM: Relationship to child/ young person (tick below): Mother Father Other (please specify) : NHS ID: Service allocated case ID 1/1 Anxious Generally(Generalized Anxiety) Parent/Carer 71 Questions 2003 Bruce F. Chorpita, Ph.D